Confidential Medical History Form
Have you tested positive for COVID-19 recently?
Do you currently have a raised temperature or fever? (Feel hot to touch on your chest/back)
Do you currently have any of the following: partial/total loss of your sense of smell or taste, a sore throat, runny nose, cough, cold or flu?
Have you had any COVID19 vaccinations?
DentalHouse will never give your information to a third party for marketing purposes. We will only share relevant information from your dental records with other professionals when clinically required, for example when we need to refer you to hospital or specialist services.
To indicate consent please enter the following details: